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Social Security, Medicare, & Medicaid

    Results: 18

  • Help with Medicaid Applications (3)
    FT-1000.9500

    Help with Medicaid Applications

    FT-1000.9500

    Programs that provide assistance for prospective or current public financial assistance recipients who are having difficulty understanding and/or obtaining the full benefits to which they are entitled by law under various income support entitlement programs. The programs may help people understand the eligibility criteria for benefits, how much they can work without affecting their benefits (for some programs), the benefits provided by the program, the payment process and the rights of beneficiaries; provide consultation and advice; help them complete benefits application forms; negotiate on their behalf with public assistance benefits staff; and/or represent them in administrative hearings or judicial litigation. Included are welfare rights organizations that offer a range of advocacy services as well as legal aid programs that offer more formalized legal assistance. Entitlement programs include (but are not limited to) General Relief (GR), Temporary Assistance to Needy Families (TANF), Food Stamps/SNAP, Medicaid, Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI).
  • Long Term Care Options Counseling (2)
    LH-4600

    Long Term Care Options Counseling

    LH-4600

    Programs that offer an interactive decision support process that helps individuals in need of long term care and their families understand their strengths, needs, preferences and unique circumstances and weigh the pros and cons of available alternatives. The consultation includes a discussion of the factors to consider when making long term care decisions, information about the range of long term care support options available in their community (such as personal care, transportation and medication management) and resources that can help them pay for services. The program also provides decision support to help identify next steps in the process and help in connecting with services, if needed. The service is generally available to older adults and adults of any age who have a disability; can be of benefit to people using their own resources to pay for services; and may be provided over the telephone or in person (at home, at an agency, in a hospital, at a rehabilitation or nursing facility or in another setting of the person's choosing). The objective of the program is to allow people to live as independently as possible in the setting of their choice.
  • Medicaid (8)
    NL-5000.5000

    Medicaid

    NL-5000.5000

    A combined federal and state program administered by the state that provides medical benefits for individuals and families with limited incomes who fit into an eligibility group that is recognized by federal and state law. Each state sets its own guidelines regarding eligibility and services within parameters established at the federal level. Many people are covered by Medicaid, though within these groups, certain additional requirements must be met. Eligibility factors include people's age, whether they are pregnant, have a disability, are blind, or aged; their income and resources (like bank accounts, real property or other items that can be sold for cash); and whether they are U.S. citizens or lawfully admitted immigrants. Families who are receiving benefits through TANF and individuals who receive SSI as aged, blind and disabled are categorically eligible groups. The rules for counting a person's income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes, for people served under the Medicaid Waiver program, for people served by Program of All-Inclusive Care for the Elderly (PACE) programs and for children with disabilities living at home. Medicaid makes payments directly to a person's health care provider; and some recipients may be asked to pay a small part of the cost (co-payment) for some medical services. Most states have additional "state-only" programs to provide medical assistance for specified low-income persons who do not qualify for the Medicaid program.
  • Medicaid Applications (2)
    NL-5000.5000-520

    Medicaid Applications

    NL-5000.5000-520

    County or state offices that accept applications and determine eligibility for the Medicaid program; and reinstate individuals who have lost their Medicaid benefits due to incarceration, institutionalization, noncompliance or other reasons. Also included are other programs that help people prepare and file Medicaid applications and/or are authorized to do eligibility determinations for the program.
  • Medicaid Estate Recovery Programs (1)
    NL-5000.5000-560

    Medicaid Estate Recovery Programs

    NL-5000.5000-560

    Programs that are responsible for implementing the 1993 federal legislation that makes it mandatory for states to attempt to recover Medicaid payments for recipients from their estates after they die; and/or which provide information about the program. Since most tangible assets are spent through Medicaid spend down, estate recovery focuses on real property, personal property or business ownership that the deceased had an interest in just prior to receiving Medicaid. Recovery applies to individuals who were age 55 or older when they received Medicaid or to permanently institutionalized adults younger than age 55. Recovery can also occur from the estate of living recipients who are in a nursing home and who have been certified that they cannot reasonably be expected to be discharged and return home. The property is exempt from estate recovery if the recipient's spouse is living there, a blind or permanently disabled child lives there, or if as a result of a state lien, additional protection for siblings and adult children can be satisfied.
  • Medicaid Information/Counseling (6)
    LH-3500.4900

    Medicaid Information/Counseling

    LH-3500.4900

    Programs that offer information and guidance for people who may qualify for Medicaid including those who do not have access to insurance provided by an employer, cannot afford privately purchased health insurance or cannot afford the out-of-pocket costs associated with a health insurance plan they may have in place with the objective of empowering them to make informed choices. Included may be information about the eligibility requirements for Medicaid and how to apply; Medicaid Managed Care options including benefits covered (and not covered) by the program; the payment process for co-payments; Medicaid "spend-down" (the process of reducing the assets an individual possesses in order to qualify for Medicaid); and information about Medicare and the linkages between the two programs. The program may also answer questions about Medicaid services available to individuals with disabilities; and some programs may help people who qualify with enrollment and provide referrals to providers who accept State Medicaid health insurance.
  • Medicare Card Replacement (1)
    NS-8000.5000-525

    Medicare Card Replacement

    NS-8000.5000-525

    Programs that allow Medicare recipients to request replacements for a lost, stolen or damaged Medicare card online by visiting the Medicare Card Replacement section of the Social Security website. Replacement cards are mailed within 30 days. People needing immediate proof that they have Medicare coverage can call a toll-free number or visit their local Social Security office.
  • Medicare Enrollment (3)
    NS-8000.5000-560

    Medicare Enrollment

    NS-8000.5000-560

    Social Security offices that accept applications for enrollment in and determine eligibility for the Medicare program. People who have signed up for early retirement benefits with the Social Security Administration or the Railroad Retirement Board apply for Medicare at that time and receive their Medicare card in the mail automatically prior to their 65th birthday. Individuals who wait for full retirement age to sign up for SSA cash benefits will need to apply for Medicare approximately three months prior to their 65th birthday month at the Social Security office where they will do the paperwork and designate if they want Part A and/or B. They will get their Medicare card in the mail showing their enrollment (Part A and/or B) with an effective date, the first of their birthday month. These people are now enrolled in Original Medicare and can sign up with a supplement or Medicare Prescription Drug Plan (Part D), or have the option of receiving their Medicare benefits through a Medicare Advantage plan (HMOs, PPOs, special needs plans, private fee for service plans). If they choose to enroll in a Medicare Advantage plan, they will have to determine availability and which plan is best for them, and then will need to enroll directly with the plan of their choice. Information about Medicare Advantage plans is available in the Welcome to Medicare handbook people receive when they enroll, by calling 1-800-MEDICARE or by using the personal plan finder on the Medicare website. Also included are other programs that help people prepare and file Medicare enrollment applications and/or are authorized to do eligibility determinations for the program.
  • Medicare Fraud Reporting (2)
    FN-1700.3350-550

    Medicare Fraud Reporting

    FN-1700.3350-550

    Programs that provide a hotline or other mechanisms that persons with Medicare and the public at large can use to report health care providers or beneficiaries who make false statements or representations which result in an unauthorized payment by the Medicare program to themselves or another. Also included are organizations that accept and investigate reports about fraudulent entities that misrepresent themselves as approved Medicare Part D Prescription Drug Plans; approved plans that use aggressive marketing tactics, discriminate against a beneficiary (e.g., prevent them from signing up for a plan based on their age, health status, race or income), entice beneficiaries to enroll in a more costly plan than they require, or erroneously charge beneficiaries for medication provided under the plan they have selected; or pharmacies that provide a different drug than the one prescribed by the physician. Examples of Medicare fraud include incorrect reporting of diagnoses or procedures to maximize payments; billing for services, medical supplies, equipment or medications not provided; misrepresentation of the dates and descriptions of services or medications provided, the identity of the recipient or the individual furnishing services; and billing for noncovered or nonchargeable services as covered items. Also included are programs that provide consumer education, counseling and assistance with the objective of helping people identify instances of fraud.
  • Medicare Information/Counseling (3)
    LH-3500.5000

    Medicare Information/Counseling

    LH-3500.5000

    Programs that offer information and guidance for older adults and people with disabilities regarding their health insurance options with the objective of empowering them to make informed choices. Included is information about the eligibility requirements for Medicare; selection and enrollment in a Medicare prescription drug plan; benefits covered (and not covered) by the program; the payment process; the rights of beneficiaries; the process for determinations, coverage denials and appeals; consumer safeguards; and options for filling the gap in Medicare coverage. These programs also provide counseling and assistance about the subsidies that are available to low income beneficiaries enrolled in the Part D Prescription Drug Benefit; and may also provide information about Medicaid and the linkages between the two programs, referrals to appropriate state and local agencies involved in the Medicaid program, information about other Medicare-related entities (such as peer review organizations, Medicare-approved prescription drug plans, fiscal intermediaries and carriers), and assistance in completing Medicare insurance forms.
  • Medicare Part B Providers (1)
    LN-4900

    Medicare Part B Providers

    LN-4900

    Physician services and outpatient health care providers that accept Medicare Part B as a means of payment. Providers include physicians and physicians' groups; physical, occupational, speech therapists; pathologists; clinical social workers; clinical psychologists; outpatient hospital services; rural health clinics; outpatient rehabilitation facilities; ambulance service providers (limited); x-ray treatment services; radiation treatment services; providers of prostheses, braces and medical equipment and supplies; home health care providers; certain mammography screening programs; and providers of certain injectable drugs (limited). Providers who "accept assignment" agree to accept payment at Medicare's allowed rate.
  • Medicare Part D Low Income Subsidy (Extra Help) Applications (3)
    NS-8000.5000-600

    Medicare Part D Low Income Subsidy (Extra Help) Applications

    NS-8000.5000-600

    Social Security offices that accept applications and determine eligibility for the subsidies that are available to low income beneficiaries enrolled in the Medicare Part D Prescription Drug Benefit. Beneficiaries may also apply for the subsidy through the online application available on the Social Security Administration website. Also included are other programs that help people prepare and file Medicare Part D Low Income Subsidy applications and/or are authorized to do eligibility determinations for the program.
  • Medicare Savings Programs (4)
    NL-5000.5000-700

    Medicare Savings Programs

    NL-5000.5000-700

    Programs that pay all or a portion of Medicare costs for low income Medicare beneficiaries with limited resources/assets. The programs are administered by Medicaid medical assistance offices, pay all or a portion of Medicare premiums and may pay Medicare deductibles and co-insurance. Included are the Qualified Medicare Beneficiary (QMB) program that pays Medicare premiums, deductibles and co-payments for people with combined incomes that do not exceed 100 percent of the federal poverty level; the Specified Low-Income Beneficiary (SLMB) program that pays Medicare Part B premiums for people with combined incomes between 100 and 120 percent of the federal poverty level; the Qualifying Individuals (QI) program that pays Medicare Part B premiums for people with combined incomes 120 and 135 percent of the federal poverty level; and the Qualified Disabled and Working Individuals (QDWI) program that helps pay the Part A premium for individuals under age 65 who have a disability and are working, have lost their premium-free Part A when they returned to work, are not receiving medical assistance from their state and meet income and resource limits required by their state. The QI program is available on a first come, first served basis. Asset/resource limits are uniform for the QMB, SLMB and QI programs and are $7,160 for single individuals and $10,750 for married couples. Resource limits for the QDWI are $4000 in countable assets/resources for individuals and $6000 for married couples.
  • PACE Programs (3)
    NL-5000.6800

    PACE Programs

    NL-5000.6800

    A capitated benefit authorized by the Balanced Budget Act of 1997 (BBA) that features a comprehensive service delivery system and integrated Medicare and Medicaid financing. For most participants, the comprehensive service package permits them to continue living at home while receiving services rather than being institutionalized. Capitated financing allows providers to deliver all services participants need rather than being limited to those reimbursable under the Medicare and Medicaid fee-for-service systems. The BBA established the PACE model of care as a permanent entity within the Medicare program and enables States to provide PACE services to Medicaid beneficiaries as a State option. The State plan must include PACE as an optional Medicaid benefit before it can enter into program agreements with PACE providers. Participants must be at least 55 years of age, live in the PACE service area, and be certified as eligible for nursing home care by the appropriate State agency. The PACE program becomes the sole source of services for Medicare and Medicaid eligible enrollees. PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral services in accordance with the participant's needs. The care is overseen by an interdisciplinary team, consisting of professional and paraprofessional staff.
  • Social Security Disability Insurance (2)
    NS-1800.8000

    Social Security Disability Insurance

    NS-1800.8000

    A federal program administered by the Social Security Administration that provides monthly cash benefits for disabled workers who are fully insured under the program, who are not capable of substantial gainful work and who have completed a five month waiting period.
  • Social Security Disability Insurance Applications (2)
    NS-1800.8000-820

    Social Security Disability Insurance Applications

    NS-1800.8000-820

    Social Security offices that accept applications and determine eligibility for the Social Security Disability Insurance (SSDI) program; and reinstate individuals who have lost their SSDI benefits due to incarceration, institutionalization, noncompliance or other reasons. Also included are other programs that help people prepare and file Social Security Disability Insurance applications and/or are authorized to do eligibility determinations for the program.
  • Social Security Retirement Benefits (2)
    NS-7000.8000

    Social Security Retirement Benefits

    NS-7000.8000

    A program administered by the Social Security Administration that provides monthly cash payments (sometimes called old-age insurance benefits) for people age 62 and older who are fully insured. Workers may retire at age 62 and receive a reduced benefit or may wait until age 65 and receive a full benefit. Benefit amounts depend upon wages earned and the number of quarters of coverage credited to the individual's Social Security record.
  • State Medicaid Waiver Programs (2)
    NL-5000.5000-800

    State Medicaid Waiver Programs

    NL-5000.5000-800

    Medicaid programs offered by states that have been authorized by the Secretary of the U.S. Department of Health and Human Services (HHS) to waive certain Medicaid statutory requirements giving them more flexibility in Medicaid program operation. Included are home and community care based (HCBC) waiver programs operated under Section 1915(c) of the Social Security Act that allow long-term care services to be delivered in community settings; managed care/freedom of choice waiver programs operated under Section 1915(b) of the Social Security Act which allow states to implement managed care delivery systems or otherwise limit individuals' choice of provider under Medicaid; and research and demonstration project waiver programs operated under Section 1115 of the Social Security Act to projects that test policy innovations likely to further the objectives of the Medicaid program. Each of the states has developed waivers to meet their needs; and while every state's waiver programs have their own unique characteristics, there may also be common threads.
 
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